• Images in cardiology

A 47 year old man with congenital heart block had a permanent DDD pacemaker implanted at the age of 25 years. Six months ago he had a battery change in the right infraclavicular region, which was his seventh box change. The pacemaker check recently undertaken showed satisfactory pacemaker function. On the day of admission he went to have a meal on his son’s birthday. As he was stretching his right arm to lift a heavy plate he had a funny sensation in his right arm. Then he noticed that he felt very dizzy and was about to pass out each time he abducted his right arm to have a meal. He came to hospital with his right arm tightly adducted to the chest wall.

A chest x ray revealed partial fracture in the ventricular lead, hence it was losing electrical contact during arm abduction. The patient was taken to the catheter laboratory and a new ventricular lead and battery was implanted. This cured his problem and he went home with an asymptomatic handshake!

Lead fracture of a permanent pacemaker is a recognised complication but this sort of dramatic presentation is rare.